Paraphimosis

Classification according to ICD-10
N47	Foreskin hypertrophy, phimosis and paraphimosis
ICD-10 online (WHO version 2019)

Paraphimosis

Paraphimosis (also Spanish collar ) is a medical emergency when a narrowed foreskin (phimosis) pinches the glans of the penis. If the foreskin is not pulled back, edematous swelling occurs. The foreskin can swell so much that necrosis of the glans can occur.

causes

The Paraphimosis arises when the forcibly retracted to close foreskin behind the glans ( glans forms a constriction). Such a constriction is often caused by improper medical or nursing manipulation of the penis, for example after inserting a trans- urethral indwelling urethral catheter , if it was forgotten to slide the foreskin back over the glans; or attempting to manually eliminate a misdiagnosed phimosis in children. Paraphimosis can also develop during or after sexual intercourse or while masturbating.

Symptoms

Paraphimosis initially constricts the more external venous vessels and thus the outflow of blood. A highly painful, edematous swelling of the foreskin and glans occurs due to the accumulation of tissue fluid. This also compresses deeper tissue where arterial blood vessels are located. In the further course of this, the arterial blood flow is impaired and possibly even interrupted. If left untreated, this circulatory disorder leads to the tissue of the glans dying off (glans gangrene ).

therapy

The paraphimosis is first treated by a reduction attempt by a doctor, preferably an experienced urologist. After squeezing out the tissue fluid in the penis foreskin, an attempt is made with gentle force to push the foreskin back over the glans. The doctor almost always succeeds in pushing the foreskin back over the glans after a few minutes of correctly squeezing it out. If the treatment is too painful, the doctor will apply anesthetics to the nerve at the base of the penis. To prevent further paraphimosis or if repositioning of the foreskin fails, a circumcision ( circumcision ) is carried out in consultation with the patient.

Circumcision is usually carried out on an outpatient basis in children and adults; inpatient therapy is also possible if the risk of surgery is increased due to accompanying illnesses.

King Philip III from Spain and Portugal with then typical "Spanish collar"

Common name "Spanish collar"

Paraphimosis is also called “Spanish collar” based on its appearance, “because the glans rests on this collar like the head of a Spanish grandee of the XV. Century on the broad ruff ”.

literature

• JM Choe: Paraphimosis: Current Treatment Options. In: American family physician. Volume 62, Number 12, December 2000, pp. 2623-6, 2628, ISSN  0002-838X . PMID 11142469 . (Review).
• S1 guideline phimosis and paraphimosis of the German Society for Pediatric Surgery (DGKCH). In: AWMF online (as of 2013)

Individual evidence

1. ^ Burkhard Paetz: Surgery for nursing professions . Thieme, Stuttgart, 2009, ISBN 3133329219 , p. 415.
2. ↑ Edmund Lesser: Encyclopedia of Skin and Venereal Diseases . Vogel, 1900, p. 379.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !